Individual provider Active NPI

Michael Anthony Bonner

  • Massage Therapist
  • San Diego, CA
National Provider Identifier
1629914932
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
101233 Issued in CA
Practice address
4295 Gesner St Ste 1B
San Diego, CA 92117-6626
Phone
(858) 829-3205
NPI assigned
Apr 28, 2026
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 101233 CA Primary

Addresses

Primary practice location

4295 Gesner St Ste 1B
San Diego, CA 92117-6626

Mailing address

13021 Wanesta Dr
Poway, CA 92064-4507
Phone (858) 829-3205

Other practice location 1

2180 Garnet Ave
San Diego, CA 92109-3610
Phone (858) 829-3205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
101233CAMDMassage Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1777334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1629914932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13021 WANESTA DR",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644507",
            "telephone_number": "858-829-3205",
            "fax_number": "858-829-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4295 GESNER ST STE 1B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921176626",
            "telephone_number": "858-829-3205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2180 Garnet Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921093610",
            "country_code": "US",
            "telephone_number": "858-829-3205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONNER",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-04-28",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "101233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.